THE THREE-LEVEL ACUPUNCTURE BALANCE Integrating Japanese Acupuncture with AcuGraph Computer Diagnosis Jake Paul Fratkin, OMD, L.c. PART 1 ANTECEDENTS TO 3-LEVEL PROTOCOL A. Overview and Introduction p. 2 B. Schools of Acupuncture Practiced in the West 5 C. Acupuncture: General Considerations 6 D. Level One: The Primary Channels 8 E. Level One: Keriaku Chiryo 9 F. Level Two: The 8 Extraordinary Channels 13 G. Level Three: Divergent Channels 16 H. 3-Level Antecedents From Japan 17 I. Somato-Auricular Therapy (SAT) 31 PART 2 THE 3-LEVEL PROTOCOL A. Acugraph Diagnosis 35 B. Abdomen and Head 37 C. Basic 3-Level Protocol 37 D. Mop-Up Treatment 38 E. 5-System Tai Ji Balance Method 40 F. Naomoto: Midday-Midnight Needling Method 42 G. Auriculotherapy 42 H. Back Treatment 42 I. Considerations 43 J. Clinical Observations 45 Qi Gong Exercises 48 Recommended Texts 50 Resources 52 2 PART 1 ANTECEDENTS TO 3-LEVEL PROTOCOL A. OVERVIEW AND INTRODUCTION 1. What I hope To Accomplish a. Theory and Practice 1. Theory a. Components of 3-Level Balance b. Japanese versus Chinese approach 2. Practice a. Point selection b. Point location c. Needle technique b. Acugraph 1. How to choose and use different menus 2. How to get accurate readings c. Therapy 1. Various systems of meridian balancing 2. Various approaches to diagnosis besides computer 3. Prioritizing the SAT protocol with ion pumping cords 4. Japanese needle technique and point location 5. Clinical problems and conundrums d. Why I like this approach 1. Complex and sophisticated balance 2. Confirmation via O-ring muscle testing 2. Three-Level Meridian Balancing is a modern approach a. Balances primary channels, divergent channels, 8 Extra b. Synthesis of a Japanese protocol based primarily on the work of 1. Yoshio Manaka, MD 2. Miki Shima, OMD c. Also incorporates the work of 1. Japanese meridian therapy (Keriaku Chiryo) 2. Dr. Richard Tan 3. Nogier and TCM auriculotherapy Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 3 3. Seeks to achieve a total meridian balance a. When meridians are in balance, the body heals quickly and efficiently b. This is a root treatment 1. Perfect for chronic cases 2. Perfect for maintenance and health enhancement c. Can be followed/accompanied by branch treatment 1. Auriculotherapy 2. TCM 3. Japanese 4. Dr. Tan/Master T’ung 4. Meridian systems (TCM approach) a. From most superficial (wei level) to deepest (yuan level): 1. Sinew channels (musculo-tendino) 2. Luo-Connecting channels 3. Primary channels 4. Divergent channels 5. Eight extraordinary channels b. Three-Layer theory (TCM approach) 1. Pathogens affect and are treated differently a. Wei 1. Treat sinew channels 2. Treat luo-connecting channels 3. Treat divergent channels b. Ying 1. Treat primary channels 2. Treat luo-connecting channels 3. Treat divergent channels c. Yuan 1. Treat extraordinary channels 2. Treat divergent channels 5. The 3-Level Protocol (Japanese approach) a. Primary channels: uses teshin devices to adjust skin above channels 1. Regulates excess and deficiency of the primary channels 2. Use teishin to release kori and other imbalances Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 4 3. Addresses primary channel imbalances after the 8 Extra and Divergent balance b. 8 Extraordinary Channels 1. Balances the musculoskeletal structure 2. Circulates energy throughout the 8 Extra network c. Divergent Channels 1. Adjusts and utilizes the divergent channels to circulate qi and blood through the zang-fu network a. Connects primaries to zang-fu 2. Harmonizes yin-yang element partners d. Auricular Therapy 1. Utilizes ear points a. To reinforce the primary channel treatment b. To address specific complaints (branch treatment) 6. Our approach relies on Acugraph computer diagnosis a. Origin was Akabane diagnosis (1970s-1980s) 1. Stroking jing-well points with incense, counting number of strokes until patient feels heat 2. Painful, time consuming 3. Requires mathematical calculations to determine treatment b. Acugraph includes the protocol within their program 1. Calculations are instantaneous 2. Gives point prescriptions c. Acugraph is also used for primary channel balance alone 7. 3 Level Balance can be performed with: a. Needles with ion pumping cords 1. Moves excess to deficiency b. Bi-metal needles c. Needles with tonification-sedation methods d. Laser e. Electro-stim f. Moxibustion Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 5 B. SCHOOLS OF ACUPUNCTURE PRACTICED IN THE WEST 1. Chinese a. TCM/CAM: based on zang-fu, 1950s 1. Foundation style taught throughout the world 2. Applies acupuncture points to zang-fu pathology b. Channel: Wang Ju-Yi c. Classical: Jeffrey Yuen, Hamid Montakab d. Taiji/Mirror Approach: Master T’ung, Richard Tan 2. Korean a. Sasang (Korean constitutional medicine) - Joseph Kim b. Korean hand acupuncture - Tae-Woo Yoo, 1971 3. Japanese a. Sawada Method - Ken Sawada (1877-1938) b. Keriaku Chiryo (Meridian Therapy) 1936-present 1. Denmai Shudo, Koei Kuwahara, Stephen Brown 2. Kodo Fukishima - Toyo Hari c. Yoshio Manaka, Stephen Birch d. Topological Society, Miki Shima e. Kiyoshi Nagano, Kiiko Matsumoto f. Masakazu Ikeda, Edward Obaidey g. Shoji Kobayashi – Acupuncture Core Therapy 1. Koshi Balancing - Jeffrey Dann h. Yoshito Mukaino - Muscle Meridian test 4. English a. Founding fathers 1. Dick Van Buren, 1950s a. Giovanni Maciocia 2. Royston Low, 1960s, 1970s 3. Felix Mann - medical acupuncture, 1970s b. J.R. Worsley – Five Element Acupuncture, 1980s 5. French a. Founding fathers Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 6 1. Georges Soulié de Morant (1878-1955); 1940 2. Roger De La Füye, 1956 3. Albert Chamfrault, physician acupuncture, 1969 b. Nguyen Van Nghi (1909-1999) (Marseille) 1. Mark Seem (New York, USA) 2. Tran Viet Dzung (Nice, France) c. Yves Requena – constitutional d. Maurice Mussat – trigram approach 1. Joseph Helms (USA) - UCLA medical acupuncture e. Paul and Raphael Nogier – auriculotherapy, 1970 to present 1. Terry Oelson (USA), 1980s 6. German a. Johannes Bischko, 1985 b. Gabriel Stux, medical acupuncture, 2003 c. Michael Weber – laser acupuncture, 2014 7. American Chiropractic a. Richard Yennie, John Amaro, Zev Myerowitz C. ACUPUNCTURE: GENERAL CONSIDERATIONS 1. Basic Concepts a. Discussion of qi and blood b. Discussion of meridian network (meridian vs. organ) c. 24 hour bio-clock 1. Follows meridian sequence in body d. Relationship of 6 levels e. Relationships of 5 Phases (element) 2. Discussion of needle and effect a. Why do needles work? 3. Comparison of Japanese to Chinese acupuncture a. Chinese TCM: 3-point combo directed towards symptom/ complaint b. Japanese: balance meridians 4. Comparison of Japanese to Chinese styles of acupuncture a. Needle technique b. De Qi Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 7 COMPARISON OF CHINESE AND JAPANESE NEEDLE TECHNIQUES Chinese Japanese Insertion of needle Deep: 10-75 mm Superficial: .5-20 mm Needle Thickness Thick: 0.20 mm (#36) Thin: 0.12 mm (#44) - 0.35 mm (#28) - 0.18 mm (#38) Point Placement Follows the body’s anatomy Touches the skin to sense active point De Qi The patient feels the The practitioner feels the arrival of qi arrival of qi through the needle Moxibustion Indirect treatment: Direct treatment: Influences a large area Uses small cones burned on the skin surface on the skin surface COMPARISON OF NEEDLE SIZES Japanese # Color Chinese gauge # Thickness (mm) 00 (02) Dk green 44 .12 0 (01) Lt green 42 .14 1 Red 40 .16 2 Ivory 38 .18 3 Blue 36 .20 4 Pink 34 .22 5 Purple 32 .25 Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 8 D. LEVEL ONE: THE PRIMARY CHANNEL BALANCE 1. Ling Shu chapter 15 described the meridian flow as a circuit a. LU > LI > ST > SP > HT > SI > BL > KI > PC > TW > GB > LV > LU 1. There are contradictory statements in the Ling Shu a. The final circuit was not confirmed until 1341, Shi Si Jing Fa Hui (“Fourteen Channels Elucidation”), Hua Bo- Ren 2. Ultimately, the primary channel circuit is the most important flow in the body a. Qi continuously flows through the circuit b. Explains jet-lag 3. Should be maintained daily a. Primary Channel qi gong b. Manaka’s Taiji treatment 2. Health is maintained when there is a continuous flow of qi through the channel circuit, and when the overall quality of qi is good a. Primary channels are responsible for circulation of qi, blood, ying and wei b. In disruption, some channels will show excess, and some will show deficiency c. Determining excess and deficiency 1. Pulse 2. Skin palpation 3. Channel and point palpation 4. Abdomen 5. Computer diagnosis: Acugraph, MEAD 3. The Six Levels a. Organization 1. Tai yang Greater yang SI-BL 2. Shao yang Lesser yang TW-GB 3. Yang ming Yang brightness LI-ST 4. Tai yin Greater yin LU-SP 5. Shao yin Lesser yin HT-KI 6. Jue yin Terminal yin PC-LV Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 9 b. Depth in body 1. Placement on arms and legs, from lateral to medial, corresponds with depth of associated organ 2. Yang channels, from most superficial to deepest a. Tai yang: Small Intestine, Bladder Lateral b. Shao yang: Triple Warmer, Gallbladder Central c. Yang ming: Large Intestine, Stomach Medial 3. Yin channels, from most superficial to deepest a. Tai yin: Lung, Spleen Medial b. Jue yin: Pericardium, Liver Central c. Shao yin: Heart, Kidney Lateral c. For deeper discussion, see HANDOUT ADDENDUM, Wang Ju-Yi’s Observations on Six Levels, p. 1 E. LEVEL 1: KERIAKU CHIRYO 1. Balancing based on Keriaku Chiryo: Japanese Meridian Therapy a. Excesses and deficiencies are determined by pulse position comparisons b. Relationships are seen as primary or secondary patterns c. Primary patterns (sho) 1. Spleen 2. Lung 3. Kidney 4. Liver 5. (Heart) d. History 1. The effects of the Meiji Restoration 2. Rebirth of Nanjing Classical Acupuncture as Japanese Meridian Therapy 3. Point selection: a. Designations and groupings of points b. Father-mother-child relationship. 69th chapter. e. Based on 69th Chapter of Nan Jing (180 AD): 1. “In a case of deficiency, fill the respective meridian’s mother. In a case of excess, sedate the respective meridian’s child. One must first fill, and sedate afterwards.” Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com 10 f. Development 1. 1930-1940s: Sorei Yanagiya, Sodo Okabe, Keiri Inoue 2. 1940-1985: Kodo Fukushima 3. 1980s-present: Denmai Shudo, Akizo Okada, Masakazu Ikeda, Kuei Kuwahara, Stephen Brown PRINCIPLES OF MERIDIAN THERAPY From: TRADITIONAL JAPANESE ACUPUNCTURE: FUNDAMENTALS OF MERIDIAN THERAPY, Society of Traditional Japanese Medicine, Koei Kuwahara, editor; Complimentary Medicine Press, 2003 1. Affirmation of the existence of meridians 2. The view that all diseases will manifest as a change in the meridians 3. Changes in the meridians, whether deficient or excess, are grasped by focusing on the comparison of pulse positions 4. Focusing on patterns (sho) of imbalance based on deficiency of the yin-zang organs-meridians a. Liver, Spleen, Lung and Kidney 5. The splitting of treatment between root treatment and local (branch) treatment a. These are performed simultaneously and have equal value b. Root treatments have standardized protocols 1. Root treatment focuses on one of the yin-zang organ- meridians (sho) 2. Recent effort to encourage wider point selection than just classical recommendations 6. Treatment theory: tonify deficiency and disperse excess 7. Focus on tonification a. Use shallow insertion with retained needles b. Or no insertion at all (contact needling) Jake Paul Fratkin, OMD, L.Ac. • drjakefratkin.com